Blockchain and health care’s future

Beyond the country music tropes and Bible Belt platitudes, Nashville should be best known for its place in the health care industry.

Headquartered in the city are 16 publicly traded health care companies with a combined $73 billion in global revenue, according to an impact study the Nashville Health Care Council conducted last year.

It was not surprising, then, that Distributed: Health picked iconic local structure Schermerhorn Symphony Center to host in September its first-ever conference on blockchain databases for the industry. Specifically, blockchains involve widely distributed databases that live on many individual devices instead of existing on central hubs. The innovative technology was on full display in a day of panel discussions and presentations, all exploring a step forward for health care in its hotbed.

“Nashville is blowing up,” John Bass, CEO of medical data company InVivoLink, said as he gave the event’s opening address to hundreds of attendees in the symphony hall. “We’re in a great position to be an epicenter for health care technology. I’m proud to have watched that emerge and I’m excited about the blockchain community forming, because I think it’s a key to positioning Nashville as a hub of health care technology.”

As much as the health care industry depends on Nashville, the city depends on the revenue the sector generates even more. Almost 400 health care companies operate here, accounting for 250,000 local jobs and $1.5 billion in state and local taxes, per the health care council. And as problems with the current health care system continue to emerge, there is cause for concern.

“There’s this perfect storm going on where in 2022, we’re going to reach $5 trillion in health care spending,” Bass said. “The numbers are simply getting too big. We all hope that technology — and hope specifically that blockchain technology — has a big role to play in flattening that prosperity and getting health care under control.”

An industry in poor health

Aside from the concerns of increasingly exorbitant spending, there are other causes for anxiety in health care. The industry is designed for episodic care, addressing illness and injury as they occur. As we’ve increasingly become a nation with unhealthy habits and lingering illnesses, it’s done little to adapt itself.

“The state of being healthy being hard has made us a nation with chronic conditions,” Chris Kay, chief innovation officer at Humana, said in a presentation following that of Bass. “[The health care] mindset doesn’t work anymore when you have people suffering from longtime conditions. That requires a relationship.”

In an age where information is more readily available than ever, data regarding the cost of care still remains perplexing for consumers.

“The complexity inside an insurance company about claims and payments is profound,” Kay said. “Health care is one of the few markets where the service we receive — the patient and the doctor — is disconnected from the payment.”

Finally, the caregivers themselves often lack data on patients and it can be frustratingly difficult to pass relevant patient files between doctors and information systems, Kay said.

“Doctors want to have a full record of our data but they don’t,” he said. “Interoperability is a core problem in health care.”

But hundreds of health care and technology innovators didn’t gather at the Schermerhorn to hear the things they probably already knew to be problematic in their field. Rather, they were drawn by the promise of a new technology with the potential to address these problems and revolutionize the industry. They wanted a closer look at blockchain.

A disruptive promise

Blockchain technology was popularized by the bitcoin market, with companies like Deloitte and Microsoft recently having invested in it.

In a blockchain, security is guaranteed as each piece of data is blocked with others and then verified at each point in the network of connected databases. As blocks are increasingly chained together, the data gets buried and harder to manipulate. This system replaces the need for single-point, third-party fiduciaries.

“At its core, the reason why blockchain is valuable and interesting is that you trust users in the network less and the system more,” Jeff Garzik, an original developer for bitcoin, told the opening audience. “Data in transactions is fully verified by every single network participant… Every node in that network is checking the rules.”

This level of security could make blockchains a method for storing health data, one that would be easily tapped and transferred by those with permission. Proponents argue this could be a way to give patients constant access to their wellness data and promote healthy habits in the face of chronic maladies.

“Fundamentally knowing your score as an individual, as a consumer, is the root of our ability to control our own health,” Kay said. “Imagine having your own health and wellness records available throughout your life and being able to control who sees what.”

Kay went on to paint a future where the navigability of data on blockchains leads to “zero friction points between the time a patient sees a doctor and the time the payments and settlements are made.”

On the caregiver side, blockchain is most promising in its potential to transfer relevant patient data from one place to another and provide interoperability.

“Health care is the only vertical market that has not agreed upon an interoperability program at this point,” Ed Cantwell, executive director of the Center for Medical Interoperability, said during an afternoon panel session. “If they put their money where their mouth is and they adopt platforms that are standards-based… and trust-worthy, then that’s the foundation for blockchain to be wonderful.”

Potential pitfalls

There are, of course, obstacles to blockchain becoming widely adopted throughout health care.

Perhaps the main barrier will be the industry itself, which is notoriously resistant to major change. The most prominent insurance companies have little financial incentive to make the marketplace more navigable for patients as it stands now, as they benefit from the treatment of individual illnesses rather than the full spectrum of health.

Then there are the stringent regulations regarding matters as sensitive as health care. The Health Insurance Portability and Accountability Act may not account for a major disruption in the way patient information is stored before it is thoroughly vetted.

“If we were to wait for the U.S. government to mandate specific technology around blockchain, it would be at glacial speed,” said Stephanie Fetzer, a project architect at IBM and conference panelist.

Lastly, it might be the patients themselves who are most resistant to the adoption of blockchains. It will be hard for average people to put the faith of their medical records into something they don’t understand.

In short, blockchains may have to establish themselves in smaller capacities before igniting a full-scale health care revolution.

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